Health Insurance

Health Insurance Reform

While the ACA exchanges have brought about new insurance coverage opportunities for Texans, significant problems remain — and potential new ones are developing — with traditional health insurance companies and Texas’ workers’ compensation program.

Balance-Billing Ban Back in 2015 LegislatureRenewed attention in the 2015 Texas Legislative over balance billing stems in part from interim charges that tasked the Senate State Affairs and House Insurance committees to look at whether existing laws dating back to 2007 are working to inform patients ahead of time when out-of-network physicians might balance-bill them for services their health plans don't fully cover. The issue is in the national spotlight, too, with the proliferation of high-deductible and narrow-network plans sold in the Accountable Care Act insurance marketplace. New federal rules take aim at ACA plans' inadequate networks and inaccurate physician and hospital directories. The Texas Medical Association is pushing for similar health plan accountability measures at the state level, with a careful eye on legislation that could restrict out-of-network physicians' ability to balance-bill for services they legitimately provide.

The Truth About Balance BillingA pair of newly developed TMA resources examine how insurance plans' network designs and payment decisions are leaving many Texans with "surprise bills" for health care services.

Key Issues

The Truth About Balance BillingA pair of newly developed TMA resources examine how insurance plans' network designs and payment decisions are leaving many Texans with "surprise bills" for health care services.

Under New Management An Interview With TDI's Newest BossThe end of the 2013 session of the legislature marked the beginning of new leadership at the Texas Department of Insurance (TDI) as Gov. Rick Perry appointed Julia Rathgeber to the helm of the agency in late May. The Senate unanimously confirmed that appointment in June.

Texas Advocacy and Communications

2015 Legislative Testimonies and LettersTMA physician leaders are working on behalf of their profession and their patients to improve Texas health care system. During the this legislative session, TMA councils and committees are locking down and promoting health care policies to ensure Texas’ patients have access to affordable and high quality health care. Read TMA’s testimonies, comments, and letters to state lawmakers.

ACA Exchange Plans: Q&A for Texas Physicians - Updated December 2014Confused by all you've heard about the Affordable Care Act marketplace insurance plans? Do you know whether you're in — or out — of the narrow networks? How will you tell if a patient is on an exchange plan? What happens to you if patients don't make their premium payments? What, if anything, can you do about all of this? TMA answers these and other tough marketplace exchange questions.

Physicians Prepare for Round Two of the ACA MarketplaceRound two of the Affordable Care Act (ACA) health insurance marketplace launched with far less fanfare than last year's botched rollout. But even as physician practices do their part to adjust and help care for these newly insured, some of the same uncertainties linger. And with potentially new twists ahead, TMA officials once again remind physicians to be mindful in their business practices surrounding exchange plans.

83rd (2013) Legislative VictoriesIt took more than six years, but TMA and our state legislators never gave up. Now a new law regulating silent PPOs penalizes unethical third parties who steal and resell physicians’ discounted rates, for commercial and Medicaid contracts. Lawmakers also passed a prompt-pay law for Medicaid HMOs; no more low-pay, slow-pay, no-pay.